Transseptal guidewire

ABSTRACT

A transseptal guidewire and methods for perforating the intra-atrial septum of the heart are disclosed. The transseptal guidewire has an elongated body, an end section biased in a curved configuration to define a proximal curve, and a distal section biased in a curved configuration to define a distal curve, the distal curve being oriented in a direction generally opposite that of the proximal curve.

CROSS REFERENCE TO RELATED APPLICATIONS

This continuation-in-part application claims priority of U.S.non-provisional application Ser. No. 11/875,365, filed Oct. 19, 2007 nowabandoned, the entire disclosure of which is incorporated herein byreference.

FIELD OF THE INVENTION

The present invention relates generally to less invasive surgicalequipment and surgical procedures. More particularly, the presentinvention relates to devices and methods for crossing from the rightatrium to the left atrium by perforating the intra-atrial septum of theheart for the treatment of intracardiac arrhythmias and defects such as,for example, atrial fibrillation and valve defects related to cardiacdisease as well as for pacing, ablating, and correction of otherstructural defects.

BACKGROUND OF THE INVENTION

Since the 1950's, transseptal procedures of the heart have beentraditionally performed using Brockenbrough needles in which a punctureis made through an intact atrial septum from the right atrium to theleft atrium. Several risks, however, have been associated with the useof Brockenbrough needles. One risk is the perforation of the lateralatrial wall after crossing the atrial septum. Another risk is thepotential perforation of the aortic root.

Attempts have been made to reduce these and other risks. For example,U.S. Pat. No. 5,312,341 relates to the problem of inadvertent withdrawalof a catheter tip from the left atrium, through the atrial septum, andback into the right atrium. A retaining means for retaining the distaltip of a sheath which has been placed through a septum, such as theinteratrial septum, across the septum, in the left atrium during leftheart procedures was therefore proposed.

U.S. Pat. No. 6,650,923 relates to a method for accessing the leftatrium by locating the fossa ovalis of the intra-atrial septum. Anaccess catheter with a detector for identifying and providing accessthrough the fossa ovalis was proposed.

U.S. Patent Publication No. 2006/0064062 relates to transseptal punctureneedles and transseptal puncture needle assemblies. More specifically,it relates to curved transseptal puncture needles and needle assembliesthat facilitate insertion through curved transseptal introducers. Eachcurved transseptal puncture needle includes a needle tip with atangential back bevel configuration, a reverse tangential back bevelconfiguration, or a conical reverse bevel configuration.

U.S. Patent Publication No. 2005/0101984 relates to septal puncture inpatients in which a communication is present between the two atria ofthe heart, for example, a patient with a patent foramen ovale (PFO). Adevice and method are proposed to safely puncture both an intact atrialseptum and an atrial septum having a PFO. The proposed device includes ablunt outer needle, and a second inner needle disposed longitudinallythrough the lumen of the outer needle, wherein the inner needle isflexible, e.g., has a flexible portion and/or a bend or othernon-traumatic conformation at its tip.

U.S. Patent Publication Nos. 2005/0159738 and 2005/0065507 relate todevices for septal perforation utilizing radio frequency energy. Eachdevice includes a functional tip with at least one active electrodecapable of creating a controlled perforation in body tissue. The deviceis introduced into the right atrium and the functional tip is positionedagainst the atrial septum. Energy is applied to the tip to create theperforation.

U.S. Pat. No. 6,890,353 relates to a method and apparatus for reducingmitral regurgitation by applying a force to the wall of the coronarysinus so as to force the posterior leaflet anteriorly and thereby reducemitral regurgitation. A guidewire uses a sharp tip for allowing thedistal end of a guidewire to penetrate tissue.

U.S. Patent Publication No. 2006/0241648 relates to methods andapparatus for modifying tissue. The proposed method includes advancing abeveled distal tip of a guide member to facilitate advancement of theguide member through tissue. A modification device is advanced along theguide member.

Nevertheless, there remains a need for improved devices and methods forperforating the intra-atrial septum of the heart with devices thatimprove the safety of the procedure.

SUMMARY OF THE INVENTION

In one aspect, a transseptal guidewire configured to perforate theintra-atrial septum is provided. The transseptal guidewire has anelongated body, an end section biased in a curved configuration todefine a proximal curve, and a distal section biased in a curvedconfiguration to define a distal curve, the distal curve being orientedin a direction generally opposite that of the proximal curve.

In another aspect, a system configured to perforate the intra-atrialseptum is provided. The transseptal access system includes a walldefining a lumen extending from a proximal section to a distal opening.The lumen is reduced in size from a first diameter in the proximalsection to a second diameter at the distal opening that is smaller thanthe first diameter. A transseptal guidewire is configured to be insertedinto the lumen of the transseptal access system. The transseptalguidewire has a distal section with a longitudinal axis and aperforating tip laterally offset from the longitudinal axis. Theperforating tip of the transseptal guidewire is configured to be offsetfrom the wall of the transseptal access system a distance that is equalto or smaller than the second diameter of the lumen of the transseptalaccess system, thereby reducing or avoiding contact between theperforating tip of the transseptal guidewire and the wall as theperforating tip is advanced distally through the distal opening of thetransseptal access system.

In yet another aspect, a system configured to perforate the intra-atrialseptum is provided having a transseptal access system including a walldefining a lumen that has a first section with a first diameter and asecond section with a second diameter smaller than the first diameter. Atransition step is defined between the first and second sections. Atransseptal guidewire is configured to be inserted within the lumen ofthe transseptal access system, the transseptal guidewire having anelongated body and a distal section. The distal section has alongitudinal axis and a perforating tip laterally offset from thelongitudinal axis. The perforating tip of the transseptal guidewire isconfigured to be offset from the wall of the transseptal access system adistance that is equal to or larger than the transition step definedbetween the first and second sections of the lumen, but equal to orsmaller than the sum of the transition step and the second diameter.Thus, contact between the perforating tip and the transition step isreduced as the perforating tip is advanced through the lumen from thefirst section to the second section of the lumen.

In still another aspect, a system configured to perforate theintra-atrial septum is provided having a transseptal access systemdefining a lumen, the lumen having a first section with a firstdiameter, a second section with a second diameter smaller than the firstdiameter, and a transition step defined between the first section andsecond section. A transseptal guidewire is configured to be insertedwithin the lumen of the transseptal access system. The transseptalguidewire has an elongated body, an end section biased in a curvedconfiguration to define a proximal curve, a distal section biased in acurved configuration to define a distal curve, and a distal perforatingtip. The distal curve is oriented in a direction generally opposite thatof the proximal curve, thereby avoiding contact between the perforatingtip and the transition step as the perforating tip is advanced throughthe lumen from the first section to the second section of the lumen.

In another aspect, a system configured to perforate the intra-atrialseptum is provided having a transseptal access system defining a lumenhaving a first section with a first diameter, a second section with asecond diameter smaller than the first diameter, and a transition stepdefined between the first section and second section. A transseptalguidewire is configured to be inserted within the lumen of thetransseptal access system and has an elongated body, a perforating tip,and means for avoiding or reducing contact between the perforating tipand the transition step as the perforating tip is advanced through thelumen from the first section to the second section of the lumen.

In yet another aspect, a method of perforating the intra-atrial septumis provided. The method includes introducing a transseptal access systemtoward the intra-atrial septum. A transseptal guidewire is constrainedwithin a lumen of the transseptal access system such that a proximalcurve defined in an end section of the transseptal guidewire and adistal curve defined in a distal section of the transseptal guidewireare oriented in generally opposite directions. The transseptal guidewireis then advanced from a first section of the lumen having a firstdiameter to a second section of the lumen having a second diametersmaller than the first diameter, while avoiding contact between aperforating tip of the transseptal guidewire and a transition stepdefined between the first section and second section of the lumen.

In still another aspect, a method of forming a transseptal guidewireconfigured to perforate the intra-atrial septum is provided. The methodincludes forming a proximal curve in an end section of an elongated bodythat it is biased in a curved configuration. A distal curve is formed ina distal section of the elongated body so the distal curve is biased ina curved configuration and oriented in a direction generally oppositethat of the proximal curve.

BRIEF DESCRIPTION OF THE DRAWING

The invention is best understood from the following detailed descriptionwhen read in connection with the accompanying drawings, with likeelements having the same reference numerals. This emphasizes thataccording to common practice, the various features of the drawings arenot drawn to scale. On the contrary, the dimensions of the variousfeatures are arbitrarily expanded or reduced for clarity. Included inthe drawings are the following figures:

FIG. 1 is a schematic representation of a heart showing an embodiment ofa transseptal trocar device positioned within the heart;

FIG. 2 is a cross-sectional side view of the transseptal trocar deviceshown in FIG. 1;

FIG. 3 is a perspective view of a transseptal guidewire of thetransseptal trocar device according to one exemplary embodiment of theinvention;

FIG. 4A is a side view of the transseptal guidewire of FIG. 3 in anintermediate stage of fabrication according to an exemplary method offabricating the transseptal guidewire;

FIG. 4B is an enlarged view of a tapered portion of the transseptalguidewire shown in FIG. 4A;

FIG. 4C is an enlarged view of a tapered distal section of thetransseptal guidewire shown in FIG. 4A;

FIG. 5 is a side view of the transseptal guidewire illustrated in FIG.4A in another intermediate stage of fabrication according to anexemplary method of fabricating the transseptal guidewire;

FIG. 6 is a side view of the transseptal guidewire illustrated in FIGS.4A and 5 according to an exemplary method of fabricating the transseptalguidewire;

FIG. 7A is a cross-sectional view of an embodiment of an imagablesection of the transseptal guidewire shown in FIG. 5 along lines 7A-7A;

FIG. 7B is a cross-sectional view of an embodiment of an ovalizedportion of an end section of the transseptal guidewire shown in FIG. 5along lines 7B-7B;

FIG. 8 is a perspective cross-sectional view of an embodiment of the endsection of the transseptal guidewire;

FIG. 9 is a schematic representation of the heart showing vascularaccess of the transseptal guidewire to the left atrium;

FIG. 10 is a perspective view of a transseptal guidewire according to aanother exemplary embodiment of the invention;

FIG. 11A is a side view of the transseptal guidewire illustrated in FIG.10 according to an exemplary method of fabricating the transseptalguidewire;

FIG. 11B is a side view of the transseptal guidewire illustrated in FIG.11A according to an exemplary method of fabricating the transseptalguidewire;

FIG. 12 is an enlarged view of a distal portion of the transseptalguidewire shown in FIG. 11B;

FIG. 13 is a plan view of a template used according to an exemplarymethod of fabricating the transseptal guidewire;

FIG. 14 is a side view of components of the transseptal trocar deviceshown in FIG. 2;

FIG. 15 is a cross-sectional side view of the transseptal guidewireshown in FIG. 10 being constrained within a transseptal needle;

FIG. 16 is a cross-sectional side view of the transseptal guidewireshown in FIG. 10 being constrained within a transseptal dilator;

FIG. 17A is a cross-sectional side view of the transseptal guidewireshown in FIG. 10 being constrained within a transseptal needle of atransseptal access system;

FIG. 17B is a cross-sectional side view of the transseptal guidewireshown in FIG. 10 being partially constrained within a transseptaldilator of a transseptal access system;

FIG. 17C is a cross-sectional side view of a distal portion of thetransseptal guidewire shown in FIG. 10 extending from the transseptalaccess system in a relaxed configuration; and

FIG. 17D is another cross-sectional side view of a distal portion of thetransseptal guidewire shown in FIG. 10 extending from the transseptalaccess system in a relaxed configuration.

DETAILED DESCRIPTION OF THE INVENTION

Aspects of the invention will now be described with reference to thefigures. Such figures are intended to be illustrative rather thanlimiting and are included herewith to facilitate the explanation of thepresent invention.

Referring generally to the figures (FIGS. 1-9), in accordance with anexemplary embodiment, a transseptal guidewire 20 configured to perforatethe intra-atrial septum 104 of the heart 100 is provided. Thetransseptal guidewire 20 has an elongated body 22, an end section 26,and a tapered distal section 28. At least a portion of the end section26 has a first dimension X in a first direction transverse to alongitudinal axis 1 of the elongated body 22 that is larger than asecond dimension Y in a second direction transverse to the longitudinalaxis 1. In an exemplary embodiment, when the transseptal guidewire 20perforates the intra-atrial septum 104 and extends into the left atrium105, the end section 26 is biased in a curved configuration to helprender end section 26 atraumatic so as to prevent perforation of theleft atrial wall.

Referring now to the individual figures in detail, FIG. 1 depicts aschematic representation of a heart 100 having a transseptal trocardevice 50 positioned within heart 100. The transseptal trocar device 50is configured to perform transseptal catheterizations for access intothe left atrium 105 of heart 100 from the right atrium 102 by way ofeither the inferior vena cava 106 or superior vena cava 108 which supplyblood into the right atrium 102 of heart 100.

By a method described in greater detail below, the transseptal trocardevice 50, which includes a transseptal sheath 10, dilator 12, outerneedle 14, and transseptal guidewire 20, is placed against a septum,such as the intra-atrial septum 104. In an exemplary embodiment, whenthe distal tip of outer needle 14 is properly positioned in contact withthe thin walled fossa ovalis 103 of the intra-atrial septum 104,transseptal guidewire 20 is abruptly extended from the lumen of outerneedle 14 to perforate the fossa ovalis 103. Following penetration ofthe intra-atrial septum 104, and without changing the position of outerneedle 14, the distal tip of dilator 12, along with the distal tip oftransseptal sheath 10 is passed through the septum and into the leftatrium 105.

At times, dilator 12 and sheath 10 do not have sufficient stiffness topass through the perforation hole (not shown) made in the fossa ovalis103. In such instances, outer needle 14 may be passed over the guidewire20 to dilate the septum prior to inserting dilator 12 and sheath 10through the perforation. The outer needle 14 can also provide supportwhile dilator 12 and sheath 10 are advanced beyond outer needle 14 andthrough the perforation hole into the left atrium 105. In anotherembodiment, dilator 12 is optionally made from material that providessufficient support during the transseptal perforation procedure and theouter needle 14 may not be needed and can be eliminated from device 50.

Referring now to FIGS. 1 and 2, aspects of the transseptal trocar device50 will be described in further detail. Transseptal trocar device 50includes a transcutaneous intravascular sheath 10 through whichcomponents of the device 50 pass from outside the patient's body througha vessel, for example, the femoral vein, through the inferior vena cava106 into the right atrium 102. Alternatively, sheath 10 may be advancedthrough a vessel located at an upper half of the body, such as thesubclavian vein, through the superior vena cava 108 into the rightatrium 102. The sheath 10 and/or other components of transseptal trocardevice 50 may have a fixed curve or may be steerable by actuators on acontrol handle (not shown) located at a proximal end of sheath 10 to aidin delivering the device 50 along the vascular path leading to thepatient's right atrium 102.

According to an exemplary embodiment, sheath 10 is made from softpolymer materials such that sheath 10 is pliable and atraumatic whenadvanced through vasculature. For example, polymers such as polyimide,polyamide, polyetherblockamide, polyethylene, polytetrafluoroethylene(PTFE), fluorinated ethylene propylene (FEP), and polyurethane may beused. Other biocompatible polymer materials that minimize damage totissue during the delivery of device 50 to the right atrium 102 may alsobe used. Transseptal trocar device 50 also includes a dilator 12slidingly positioned within a sheath lumen 11 of sheath 10 axiallydisposed along longitudinal axis 1. Dilator 12 is configured to dilate aperforation hole (not shown) made in the intra-atrial septum 104 toprovide improved access for the sheath 10 into the left atrium 105. Inan exemplary embodiment, the distal end of dilator 12 may be blunted ortapered (not shown) toward outer needle 14 to provide gradual dilationof the perforation hole as dilator 12 is slidingly advanced into theleft atrium 105.

As shown in FIG. 2, dilator 12 includes a lumen 13 which receives outerneedle 14. Outer needle 14 has a distal end that contacts intra-atrialseptum 104 to position outer needle 14 against fossa ovalis 103. In anexemplary embodiment, outer needle 14 is similar in size to aBrockenbrough needle, e.g., with tip diameter of about 0.8 mm. Outerneedle 104 also includes a lumen 15 to receive and provide structuralcolumnar support for a septal perforator, such as a transseptalguidewire 20 axially disposed within lumen 15. The inner diameter oflumen 15 typically approximates the maximum outer diameter oftransseptal guidewire 20 such that the transseptal guidewire 20 isslidable within outer needle 14. In certain embodiments, the outerdiameter of outer needle 14 gradually tapers toward transseptalguidewire 20 to also function as a dilator of the perforation hole (notshown) created in the fossa ovalis 103.

According to an exemplary embodiment, dilator 12 and outer needle 14 maybe made of a polymer material, as described above. Other materials thatprovide sufficient support during the transseptal procedure arecontemplated. For example, various metals, such as nitinol, steel, ortitanium, or alloys thereof may be used.

Referring now to FIGS. 2 and 3, aspects of the transseptal guidewire 20according to one exemplary embodiment of the present invention aredescribed in further detail. Transseptal guidewire 20 is configured toperforate the intra-atrial septum 104 and is disposed within lumen 15 sothat transseptal guidewire 20 is reciprocally and axially moveablewithin outer needle 14. If necessary, the transseptal guidewire 20 canbe rotated as well. Transseptal guidewire 20 has a length longer thanouter needle 14, for example about 15 cm longer than outer needle 14such that transseptal guidewire 20 has an overall length that is longerthan about 117.5 cm, though other dimensions are contemplated as well.In another embodiment, transseptal guidewire 20 has a length that isabout 50 cm longer than outer needle 14. The diameter of transseptalguidewire 20 is sized to fit through the lumen 15 of commerciallyavailable transseptal outer needles 14. For instance, the diameter oftransseptal guidewire 20 is less than the diameter of lumen 15 of outerneedle 14 so transseptal guidewire 20 may pass through outer needle 14with little or no resistance.

Now referring to FIG. 3, the transseptal guidewire 20 includes anelongated body 22, an end section 26, and a tapered distal section 28.The tapered distal section 28 terminates at a pointed tip 29 at thedistal end of transseptal guidewire 20. In an exemplary embodiment, whentransseptal guidewire 20 is positioned fully within outer needle 14,transseptal guidewire 20 retains a substantially straight configuration.When transseptal guidewire 20 extends through the distal end of lumen 15along longitudinal axis 1, end section 26 is no longer supported withinouter needle 14 and flexes to a curved conformation such as that shownfor illustration purposes in FIG. 3. Thus, in use, when the distal endof outer needle 14 contacts intra-atrial septum 104, transseptalguidewire 20 may extend so that pointed tip 29 perforates intra-atrialseptum 104 and is positioned in left atrium 105. As transseptalguidewire 20 continues its path along axis 1 into left atrium 105, endsection 26 curves into a non-traumatic conformation so that the lateralwall of the left atrium 105 is not exposed to pointed tip 29.Preferably, the tip 29 is sufficiently flexible so that it does not needthe curve to be atraumatic.

In an exemplary embodiment, transseptal guidewire 20 may be coated witha material to ease insertion through the lumen 15 of commerciallyavailable transseptal outer needles 14 and/or to prevent clots fromforming on the guidewire 20. For example, the entire length oftransseptal guidewire 20 or a portion of its length may be coated with amaterial that has antithrombogenic properties to prevent clots fromforming on the wire. Exemplary coatings may be hydrophobic orhydrophilic. Typical coatings may be formed from Teflon, a siliconefluid, or urethane based polymers. Other biocompatible coatings thatprovide the above mentioned properties may also be used.

As will be described in further detail below, a portion of end section26 is ovalized such that end section 26 has a substantially non-circularcross section. Ovalizing a portion of end section 26 partly assists withbiasing end section 26 in a curved configuration such as that shown inFIG. 3.

As also illustrated in FIG. 3, elongated body 22 of transseptalguidewire 20 has a portion 24 proximal of end section 26. Portion 24 hasa substantially circular cross section relative to end section 26. Inone embodiment, portion 24 is an imagable section having radiopaquemarkers 25 a-e coupled to the imagable section 24. Radiopaque markers 25a-e may be made of a platinum/iridium alloy and are sufficiently visibleunder fluoroscopy (x-ray) to assist with imaging of the operative area.In one embodiment, the radiopaque markers 25 a-e are formed by aplatinum coating or cladding. Other radiopaque materials may also beused such as palladium, gold, silver, tungsten, etc.

In an exemplary embodiment, when a portion of imagable section 24extends into the left atrium 105 from the perforation hole (not shown),x-ray imaging of radiopaque markers 25 a-e may confirm successfulperforation of the intra-atrial septum 104. Radiopacity of markers 25a-e is generally equal to, or greater than, transseptal needle 20, thuseliminating the need for radiopaque contrast solution.

Radiopaque markers 25 a-e are retained on imagable section 24 since endsection 26 is ovalized and has a dimension (such as a width) greaterthan the diameter of imagable section 24. Additionally, a portion 21 ofelongated body 22 proximal to imagable section 24 has a taperedtransition to imagable section 24 with a diameter also greater than thediameter of imagable section 24. Thus, radiopaque markers 25 a-e areretained to imagable section 24 between adjacent portion 21 and endsection 26.

Referring now to FIGS. 4A-C, 5, and 6, a method of fabricating atransseptal guidewire 20 of the present invention is illustrated. Asshown in FIG. 4A, which illustrates an intermediate configuration oftransseptal guidewire 20 during the manufacturing process, transseptalguidewire 20 has an elongate body 22 a disposed along longitudinal axis1 of transseptal guidewire 20. Transseptal guidewire 20 is optionallymade from various metals such as, for example, nitinol, steel, ortitanium, or alloys thereof or polymers such as polyimide,polyetheretherketone (PEEK), polyamide, polyetherblockamide,polyethylene, polytetrafluoroethylene (PTFE), fluorinated ethylenepropylene (FEP), and polyurethane. In an exemplary embodiment,transseptal guidewire 20 is manufactured from superelastic nitinol wirefrom Fort Wayne Metals in Fort Wayne, Ind.

In one embodiment, superelastic nitinol wire having a substantiallycircular cross-section is formed into elongate body 22 a by a centerlessgrinding process. The superelastic nitinol wire, for example, may have asubstantially uniform diameter and is threaded into a grinding machineto gradually decrease the diameter of the wire. Elongate body 22 a mayhave a maximum diameter of about 0.015 inches at a proximal portion 21 awhich is tapered by centerless grinding to portion 24 a. Portion 24 a issharpened to tapered distal section 28 terminating at pointed tip 29.Pointed tip 29 has a substantially circular cross-section and ispositioned at the distal end of tapered distal section 28.

In another embodiment, elongate body 22 a may have a maximum diameter ofabout 0.050 inches at a proximal portion 21 a when used without an outerneedle such as a Brockenbrough needle. In such an embodiment, portion 24a can be up to about 0.032 inches in diameter.

In an exemplary embodiment, after elongate body 22 a is formed,radiopaque markers (25, FIG. 3) may be slidably coupled to portion 24 ato form an imagable section (24, FIG. 3) of elongate body 22 a. Imagablesection (24, FIG. 3) has a substantially circular cross-section having adiameter of about 0.008 inches according to one embodiment. Thus, atleast a portion of imagable section (24, FIG. 3) has a cross-sectionalarea smaller than the maximum cross-sectional area defined in portion 21a of elongate body 22 a. In an exemplary embodiment, radiopaque markers(25, FIG. 3) coupled to portion 24 a may be bands that have innerdiameters greater than the diameter of portion 24 a. Radiopaque markerbands, for example, may have inner diameters greater than about 0.008inches and less than about 0.011 inches. Outer diameters of radiopaquemarker bands may be greater than about 0.010 inches.

One or more radiopaque markers (25, FIG. 3) may be mounted to portion 24a of elongate body 22 a by various coupling processes. Radiopaquemarkers, for example, may be mounted by adhesives, swaging, crimping,welding, or printing. Swaging techniques, for instance, includeplastically deforming radiopaque markers (25, FIG. 3) using highpressure so that markers are crimped onto portion 24. Adhesive bondingmethods may use low viscosity adhesives, such as cyanoacrylate, which istypically sold under trademarks like “Superglue” and “Krazy Glue.” In anexemplary embodiment, platinum/10% iridium radiopaque marker bands (25,FIG. 3) using materials available from Johnson Matthey in West Chester,Pa. are attached to imagable section (24, FIG. 3) with wicking gradecyanoacrylate adhesive from Henkel Loctite Corporation in Rocky Hill,Conn. In another embodiment, radiopaque markers (25, FIG. 3) areslidably coupled to portion 24 a without the use of adhesives or areotherwise applied.

FIGS. 4B and 4C illustrate enlarged views of tapered transitions fromportion 21 a of elongate body 22 a to adjacent portion 24 a and tapereddistal section 28. Tapered transition from portion 21 a to adjacentportion 24 a may span a length of about 0.05 inches, for example, andtaper from its maximum diameter to about 0.008 inches. As describedabove, portion 24 a and pointed tip 29 are generally formed bycenterless grinding such that portion 24 a and pointed tip 29 havediameters less than the maximum diameter of elongate body 22 a. Tapereddistal section 28 has a portion with a diameter equal to or less thanabout 0.008 inches which tapers to a sharp pointed tip 29.

Referring now to FIGS. 4A and 5, additional aspects of a procedure forforming transseptal guidewire 20 are shown. In an exemplary embodiment,after radiopaque markers (25, FIG. 3) are coupled to imagable section 24of elongate body 22 a, at least a segment of portion 24 a is ovalized orpressed using a mechanism such as a toggle press to form at least aportion of the end section 26. End section 26 is about ½ inch long andhas a substantially non-circular cross-section distal of imagablesection 24 and proximal of tapered distal section 28. As described infurther detail below, when end section 26 is ovalized or otherwisepressed or formed, end section 26 has a first dimension (such as awidth) in a direction transverse to longitudinal axis 1 that is largerthan a second dimension (such as a thickness) in a second directiontransverse to longitudinal axis 1. The first dimension of end section 26is larger than the diameter of imagable section 24 to minimize the riskof radiopaque marker bands (25, FIG. 3) migrating from or falling offelongate body 22 a.

The first dimension, for example, may have a width between about 0.008and about 0.014 inches and greater than the inner and outer diameters ofradiopaque marker bands (25, FIG. 3). Conversely, the inner diameters ordimension of radiopaque marker bands (25, FIG. 3) are preferably nolarger than, and more preferably are smaller than, the first dimensionof end section 26 such that the bands are restrained from passing overor along the end section 26. Also, the outer circumference of the bandspreferably does not exceed the maximum circumference or perimeter of endsection 26. When the outer circumference of the bands does not exceedthe maximum circumference or perimeter of end section 26, then the bandsare apt to pass more easily through an aperture in the septum formed bythe end section 26. This reduces the interference as the transseptalguidewire is advanced.

Due to ovalization or pressing or other forming, the second dimension ofend section 26 is smaller than the diameter of imagable section 24 andmay have a thickness, for example, less than about 0.008 inches such asabout 0.005 inches. Accordingly, end section 26 of the transseptalguidewire 20 is thinner and therefore more flexible than proximalportion 21 a, imagable section 24, and tapered distal section 28 in adirection of curvature about an axis parallel to the first dimension. Inother words, the end section 26, like an “I-beam,” is more flexible inone direction (about an axis parallel to the first dimension) ascompared to another direction (about an axis parallel to the seconddimension).

Referring now to FIGS. 5 and 6, end section 26 of transseptal guidewire20 is biased to a curved configuration by a heat curving process orother forming process. For example, end section 26 may be treated at anelevated temperature, such as about 500 degrees Centigrade, for a setduration, such as about 10 seconds, to curve an otherwise linearsuperelastic nitinol wire. At least a portion of end section 26 iscurved by a fixture and then cooled to retain the flexibility of thecurved configuration. Thus, when end section 26 of transseptal guidewire20 is not constrained within the lumen (13, FIG. 2) of outer needle (14,FIG. 2), end section 26 has an essentially non-traumatic conformation,such as a helical, curved, or hook shape.

For example, the radius “B” of the loop that forms the curvedconfiguration can be about 0.125 inches or the diameter may be about 5-8mm, though other dimensions are optionally selected. When the tapereddistal section 28 is enclosed within the lumen (13, FIG. 2) of outerneedle (14, FIG. 2), the entire length of the transseptal guidewire 20is substantially straight and parallels longitudinal axis 1 of outerneedle (14, FIG. 2).

FIGS. 7A and 7B illustrate cross-sectional views of transseptalguidewire 20 taken along lines A-A of imagable section 24 and lines B-Bof end section 26 shown in FIG. 5. As shown in FIG. 7A, imagable section24 has a substantially circular cross-section having a cross-sectionalarea less than the maximum cross-sectional area of elongate body (22,FIG. 6). In an exemplary embodiment, the diameter of imagable section 24is less than the maximum diameter of elongate body (22, FIG. 6),preferably a diameter of about 0.008 in. When radiopaque marker bands(25, FIG. 6) are coupled to the imagable section 24, inner diameters ofradiopaque marker bands (25, FIG. 6) are positioned adjacent thecircumference or perimeter of imagable section 24.

As shown in FIGS. 5 and 7B, end section 26 is ovalized or pressed orotherwise formed from a portion (24 a, FIG. 4 a) of elongate body (22 a,FIG. 4 a) such that end section 26 has a substantially non-circularcross-section. End section 26 has a first dimension (such as a width)that is greater than the diameter of imagable section 24. As describedabove, and according to one exemplary embodiment, the first dimension Xis between about 0.008 inch and about 0.014 inch, and is preferablyabout 0.011 inch. The second dimension Y of end section 26 is smallerthan the diameter of imagable section 24 and may have a thickness lessthan about 0.008 inch, for example, about 0.005 inch. In an exemplaryembodiment, radiopaque marker band (25, FIG. 6) has a circumference notexceeding the maximum circumference or perimeter of end section 26 suchthat radiopaque marker band (25, FIG. 6) can pass without substantialresistance through an aperture formed by the end section 26. Also, aninner dimension such as an inner diameter of the band is preferablysmaller than the largest dimension of the end section 26 so that theband may be retained on imagable section 24 and not fall off thetransseptal guidewire 20 by passing through or along end section 26.Radiopaque marker bands (25, FIG. 6) may have a pull force greater orequal to about 3 Newtons in compliance with ISO 11070, thereby securingthe bands to imagable section 24.

Referring now to FIGS. 7B and 8, when end section 26 is ovalizedaccording to the illustrated embodiment, first dimension X of endsection 26 is formed in a first direction transverse to longitudinalaxis 1 of elongate body (22, FIG. 5) and second dimension Y is formed ina second direction transverse to longitudinal axis 1. First dimension Xis larger than second dimension Y, thus end section 26 is thinner inthickness and more flexible in at least one direction as compared toproximal portion 21, imagable section 24, and tapered distal portion 28of transseptal guidewire 20.

The exemplary embodiments of end section 26 are illustratedschematically as having a portion with a cross-sectional shape that islike an oval. This oval shape may be formed by pressing or othertechniques. It is contemplated 10 that this shape may be something otherthan an oval as well, while still maintaining first and secondrespective dimensions. For example, the shape may be flattened orsomewhat rectangular. It may also take any other geometric shape. In anyshape selected, however, the subject portion of end section 26preferably serves at least one of the functions of retaining radiopaquebands, promoting increased flexibility in at least one direction, andproviding an outer perimeter close to the outer perimeter of theradiopaque bands.

Referring now to FIGS. 1, 2, 6, and 9, methods of perforating anintra-atrial septum 104 and confirming traversal of the intra-atrialseptum 104 to treat, for example, patent foramen ovale (PFO) or to gainaccess to the left atrium 105 are illustrated. As shown in FIGS. 1 and9, one exemplary method includes the step of introducing anintravascular sheath 10 in a vessel such as the inferior vena cava 106or superior vena cava 108 to access the chamber of right atrium 102. Inan embodiment, the distal end of sheath 10 is tapered to enhanceadvancement of the sheath 10 though the intra-atrial septum 104 afterperforating intra-atrial septum 104.

Referring to FIG. 1, after the sheath 10 is properly positioned in theright atrium 102, dilator 12 and outer needle 14 of transseptal trocardevice 50 are advanced distally toward the intra-atrial septum 104. Thedistal end of outer needle 14 is positioned against fossa ovalis 103 atthe perforate site and pushed against fossa ovalis 103 until sometenting of the fossa ovalis 103 is caused. The tenting should besufficient to correctly identify, preferably by fluoroscopicvisualization, the perforate site in the intra-atrial septum 104.Alternatively, visualization techniques such as intracardiacechocardiography (ICE) or magnetic resonance imaging (MRI) can be usedthat may work without tenting.

Once outer needle 14 is positioned, transseptal guidewire 20 is advancedrelative to the outer needle 14 through the septum 104. The perforationforce of transseptal guidewire 20 is less than or equal to theperforation force of currently available transseptal needles such as aBrockenbrough needle. According to one embodiment, at its most distalposition, about 10 mm of the transseptal guidewire 20 should extend fromthe distal end of outer needle 14. Alternatively, the most distalposition could be extended about 30 mm to 50 mm, e.g., 3-5 cm, if endsection 26 of transseptal guidewire 20 has a hook shape, as is shown inFIG. 6. Thus, after perforation of fossa ovalis 103, a portion oftransseptal guidewire 20 may be extended into left atrium 105 to confirmthat it is in the left atrium 105. In another embodiment, curved portionof transseptal guidewire 20 may be advanced such that the curved portionenters one of the pulmonary veins (not shown) in the left atrium 105.

In an embodiment of this procedure, as elongate body 22 is advancedthrough outer needle 14, the straight configuration of transseptalguidewire 20 shown in FIG. 2, transitions to curved configuration of endsection 26. A portion of end section 26 extends into the left atrium 105such that pointed tip 29 of the tapered distal section 28 curves backtoward the intra-atrial septum 104 as shown in FIG. 9. Imagable section24 proximal of end section 26 may then be advanced into the left atrium105 and imaged by means of at least one radiopaque marker 25 coupled tothe imagable section 24. Radiopaque markers 25 may be restricted frommovement along longitudinal axis 1 of the transseptal guidewire 20 andexclusively positioned along imagable section 24 by ovalizing orotherwise pressing or forming end section 26 as shown in FIG. 7B orotherwise changing the cross-sectional shape of the end section 26. Whenradiopaque markers 25 are positioned within the left atrium 105,traversal of the intra-atrial septum 104 and the location of transseptalguidewire 20 are confirmed by imaging of radiopaque markers 25.

In an embodiment of this procedure, outer needle 14 follows the path oftransseptal guidewire 20 through the septum 104. Alternatively, becauseof the added stiffness provided by outer needle 14, transseptalguidewire 20, dilator 12, and sheath 10 can be advanced through septum104. The motion of the transseptal guidewire 20 may be forward,vibrating, reciprocating, linear, or rotational, for example. In oneembodiment, movement of the transseptal guidewire 20 is accomplishedmanually, thus providing easier manipulation for the physician.

As shown in FIGS. 1 and 9, once the pointed tip 29 of the transseptalguidewire 20 is positioned within the septum 104, fossa ovalis 103tissue provides support to the transseptal guidewire 20 until sheath 10,dilator 12, and/or outer needle 14 is delivered into the left atrium105. According to standard catheterization procedures, once sheath 10and/or dilator 12 is positioned in the left atrium 105, other componentsof the transseptal trocar device 50, for example, the transseptalguidewire 20, outer needle 14, and dilator 12 can be retracted and thesheath 10 can be used to deliver implants, for example, such as anatrial occluder for the treatment of a patent foramen ovale,electrophysiology catheters, or other intracardiac therapeutic devices.In an embodiment of this procedure, the transseptal guidewire 20 is leftin the left atrium 105 to maintain the perforate site as well as toimage the operative area by radiopaque markers 25, or to act as aguidewire for delivery of over-the-wire devices into the left atrium. Inanother embodiment, the transseptal guidewire 20 is withdrawn, e.g.,into the outer needle 14.

The method for transseptal perforation using the transseptal devicedescribed herein offers several significant advantages. For example,when using the devices and methods according to exemplary embodiments ofthe invention, inadvertent contact of the transseptal guidewire 20 withthe left atrial free wall immediately after the septum 104 is perforateddoes not result in damage to or perforation of the left atrial free wallbecause the end section 26 of the transseptal guidewire 20 is flexibleand/or biased to a curved configuration when fully extended from thedistal end of outer needle 14. In other words, the flexibility and/orcurvature of the end section renders it atraumatic.

When the end section 26 of the transseptal guidewire 20 contacts theleft atrial free wall or pulmonary vein, for example, end section 26 oftransseptal guidewire 20 harmlessly bends rather than perforates theleft atrial free wall. In one embodiment, the end section 26 of thetransseptal guidewire 20 bends because of the enhanced flexibility ofthe ovalized end section 26, as described above. In an embodiment,perforation of the left atrial wall is avoided by modifying the shape ofthe end section 26 of transseptal guidewire 20 to form, for example, ahook or a bend. In yet another embodiment, end section 26 of transseptalguidewire 20 may be advanced into one of the pulmonary veins in the leftatrium 105 and straightened by advancing a transseptal introducer, suchas dilator 12 or sheath 10, over end section 26.

Another advantage of the transseptal trocar device embodiments describedherein is the ability of the device to perforate through thick septumsuch as septum secundum. The transseptal trocar devices according to theinvention can also be used for remote suturing of a patent foramen ovaleor other defects that may be accessed vascularly. This is possible, forexample, because the fit between the outer needle 14 and the guidewire20, especially when provided with an ovalized end section, promotes thecolumn strength of the guidewire and reduces the bending or bucklingtendency of the guidewire. This fit, promoted by the ovalized endsection, improves the ability of the guidewire to perforate toughertissue yet, when extended from the end of the needle 14, becomesrelatively atraumatic.

In an exemplary embodiment, the pointed tip of the guidewire 20 issignificantly sharper and/or smaller than the tip of the transseptalouter needle 14. Thus, the guidewire 20 is able to perforate through thefossa ovalis 103 with less force. When needle 14 punctures the fossaovalis 103, the needle 14 continues on a path towards the lateral wallof the left atrium. According to exemplary embodiments described herein,however, when the guidewire 20 is extended from the tip of thetransseptal outer needle 14, guidewire 20 prevents the needle 14 frompuncturing the lateral wall of the left atrium.

By way of example, the flexible members are manufactured usingnickel-titanium material, such as superelastic nitinol, or other shapememory alloy materials. The nickel-titanium wire, when properlymanufactured, exhibits elastic properties for the wire to be manipulated(e.g., bent) by an operator and then returned to substantially the sameshape the wire possessed prior to it being manipulated. Thus,transseptal guidewire 20 does not kink or buckle during use withtransseptal trocar device 50.

In an exemplary embodiment, components of transseptal trocar device 50are passed through a straightener and optional hemostatic Y adapter (notshown) without resistance. The hemostatic Y adapter may be used tosupply contrast imaging fluid through the sheath 10, dilator, and/orneedle 14. Alternatively, the Y adapter may be coupled to a pressuremonitor to measure atrial pressure change when the intra-atrial septum104 is perforated.

In yet another embodiment, transseptal trocar device 50 may be providedin a sterilized kit which includes intravascular sheath 10, dilator 12,outer needle 14, transseptal guidewire 20, and the hemostatic Y valve.The components of 10 the kit may be packaged in a tyvek/polymylar pouchfor one time use such that the transseptal trocar device 50 may bedisposable after a surgical procedure. Additional aspects of the Yadapter and transseptal catheterization methods are described in U.S.Pat. No. 5,312,341, U.S. Patent Publication 2006/0064062, and U.S.Patent Publication 2005/0101984, which are incorporated herein fully byreference.

FIGS. 10-17 illustrate another embodiment of a transseptal guidewire 220according to an exemplary aspect of the invention. Transseptal guidewire220 is similar to the guidewire 20 described above in connection withFIGS. 1-9, but differs in that the transseptal guidewire 220 isconfigured in such a way as to prevent the perforating tip 229 of thetransseptal guidewire 220 from catching, or reduce the risk of catching,on the inside of a component of a transseptal access system, such as aneedle or dilator, as the transseptal guidewire 220 is advanced distallythrough the transseptal access system.

For example, a transseptal needle or a transseptal dilator may define alumen that is reduced in size from a first diameter in a proximalsection to a second diameter at the distal opening that is smaller thanthe first diameter. There may also be a transition step between thefirst and second diameters. It is therefore advantageous to reduce theoccasion that the perforating tip would contact such a transition stepor diameter reduction as the transseptal guidewire is advanced distallythrough or into the transseptal needle or dilator or other suchcomponent. Referring generally to FIGS. 10-17, the transseptal guidewire220 is illustrated. The transseptal guidewire 220 is configured toperforate the intra-atrial septum and has an elongated body 222, an endsection 226 biased in a curved configuration to define a proximal curve226 a, and a distal section 228 biased in a curved configuration todefine a distal curve 228 a, the distal curve 228 a being oriented in adirection generally opposite that of the proximal curve 226 a.

A system configured to perforate the intra-atrial septum is alsoillustrated. A transseptal access system such as a system including adilator 212 (FIG. 16) or a transseptal needle 214 (FIG. 15) or acombination thereof (similar to dilator 12 (FIG. 2), transseptal needle14 (FIG. 2), or a combination of a dilator and a transseptal needle(FIG. 2)) includes a wall 232, 235 defining a lumen 213, 215 extendingfrom a proximal section 230, 216 to a distal opening 231, 217. The lumen213, 215 is reduced in size from a first diameter in the proximalsection 230, 216 to a second diameter at the distal opening 231, 217that is smaller than the first diameter. A transseptal guidewire 220 isconfigured to be inserted into the lumen 213, 215 of the transseptalaccess system 212, 214. The transseptal guidewire 220 has a distalsection 228 with a longitudinal axis 1 a and a perforating tip 229laterally offset from the longitudinal axis 1 a. The perforating tip 229of the transseptal guidewire 220 is configured to be offset from thewall 232, 235 of the transseptal access system 212, 214 a distance thatis equal to or smaller than the second diameter of the lumen 213, 215 ofthe transseptal access system 212, 214, thereby reducing or avoidingcontact between the perforating tip 229 of the transseptal guidewire 220and the wall 232, 235 as the perforating tip 229 is advanced distallythrough the distal opening 231, 217 of the transseptal access system212, 214.

In another embodiment, the transseptal access system 212 a, 214, 250(such as for example a dilator 12 (FIG. 2), a transseptal needle 14(FIG. 2), or a combination of a dilator and a transseptal needle (FIG.2)) includes a wall 232 a, 235 defining a lumen 213 a, 215 that has afirst section 233, 216 with a first diameter and a second section 234,217 with a second diameter smaller than the first diameter. A transitionstep 219, 218 is defined between the first and second sections. Atransseptal guidewire 220 is configured to be inserted within the lumen213 a, 215 of the transseptal access system 212 a, 214, 250. Thetransseptal guidewire 220 has an elongated body and a distal section228. The distal section 228 has a longitudinal axis 1 a and aperforating tip 229 laterally offset from the longitudinal axis 1 a. Theperforating tip 229 of the transseptal guidewire 220 is configured to beoffset from the wall 232 a, 235 of the transseptal access system 212 a,214, 250 a distance that is equal to or larger than the transition step219, 218 defined between the first and second sections of the lumen 213a, 215, but equal to or smaller than the sum of the transition step 219,218 and the second diameter. Thus, contact between the perforating tip229 and the transition step 219, 218 is reduced or minimized as theperforating tip 229 is advanced through the lumen 213 a, 215 from thefirst section 233, 216 to the second section 234, 217 of the lumen 213a, 215.

In yet another embodiment, a transseptal guidewire 220 is configured tobe inserted within the lumen 213 a, 215 of a transseptal access system212 a, 214, 250 (such as for example a dilator 12 (FIG. 2), atransseptal needle 14 (FIG. 2), or a combination of a dilator and atransseptal needle (FIG. 2)). The transseptal access system 212 a, 214,250 defines a lumen 213 a, 215, the lumen 213 a, 215 having a firstsection 233, 216 with a first diameter, a second section 234, 217 with asecond diameter smaller than the first diameter, and a transition step219, 218 defined between the first section 233, 216 and second section234, 217. The transseptal guidewire 220 is configured to be insertedwithin the lumen 213 a, 215 of the transseptal access system 212 a, 214,250. The transseptal guidewire 220 has an elongated body 222, an endsection 226 biased in a curved configuration to define a proximal curve226 a, a distal section 228 biased in a curved configuration to define adistal curve 228 a, and a distal perforating tip 229. The distal curve228 a is oriented in a direction generally opposite that of the proximalcurve 226 a, thereby avoiding or reducing a tendency for contact betweenthe perforating tip 229 and the transition step 219, 218 as theperforating tip 229 is advanced through the lumen 213 a, 215 from thefirst section 233, 217 to the second section 234, 217 of the lumen 213a, 215.

In yet another embodiment, the transseptal access system 212 a, 214, 250defines a lumen 213 a, 215, the lumen 213 a, 215 having a first section216, 233 with a first diameter, a second section 217, 234 with a seconddiameter smaller than the first diameter, and a transition step 218, 219defined between the first section 216, 233 and second section 217, 234.A transseptal guidewire is 220 configured to be inserted within thelumen 213 a, 215 of the transseptal access system 212 a, 214, 250 andhas an elongated body 222, a perforating tip 229, and means for reducing(or avoiding or minimizing) contact between the perforating tip 229 andthe transition step 218, 219 as the perforating tip 229 is advancedthrough the lumen 213 a, 215 from the first section 216, 233 to thesecond section 217, 234 of the lumen 213 a, 215.

The means for reducing contact between the perforating tip 229 and thetransition step 218, 219 preferably offsets the perforating tip 229 froman axis 1 a of the elongated body 222 of the transseptal guidewire 220.The reducing means is optionally a curve, a bend, or an angle formed ina distal section 228 of the transseptal guidewire 220.

A method of perforating the intra-atrial septum is also provided. Themethod includes introducing a transseptal guidewire 220 toward theintra-atrial septum. A transseptal guidewire 220 is constrained within alumen 213 a, 215 of the transseptal access system 214, 250 such that aproximal curve 226 a defined in an end section 226 of the transseptalguidewire 220 and a distal curve 228 a defined in a distal section 228of the transseptal guidewire 220 are oriented in generally oppositedirections. The transseptal guidewire 220 is then advanced from a firstsection 233, 216 of the lumen 213 a, 215 having a first diameter to asecond section 234, 217 of the lumen 213 a, 215 having a second diametersmaller than the first diameter, while avoiding contact between aperforating tip 229 of the transseptal guidewire 220 and a transitionstep 219, 218 defined between the first section 233, 216 and secondsection 234, 217 of the lumen 213 a, 215.

In yet another embodiment, a method of forming a transseptal guidewire220 configured to perforate the intra-atrial septum is provided. Themethod includes forming a proximal curve 226 a in an end section 226 ofan elongated body 222 such that it is biased in a curved configuration.A distal curve 228 a is formed in a distal section 228 of the elongatedbody 222 such that the distal curve 228 a is biased in a curvedconfiguration and oriented in a direction generally opposite that of theproximal curve 226 a.

Referring now to the figures in detail, FIG. 10 illustrates atransseptal guidewire 220 according to an exemplary embodiment. Thetransseptal guidewire 220 includes an elongate body 222, an end section226, and a distal section 228.

The end section 226 is biased in a curved configuration to define aproximal curve 226 a, such as J-shaped curve. In the illustratedembodiment of transseptal guidewire 220, the proximal curve extends adistance and over an angle sufficient that a longitudinal axis 1 a (FIG.12) of a straight portion of the distal section 228 is substantiallyparallel to the longitudinal axis 1 of the elongate body 222 of thetransseptal guidewire 220, though greater and lesser curves are alsocontemplated.

The distal section 228 is biased in a second curved configuration todefine a distal curve 228 a such that the perforating tip 229 of thetransseptal guidewire 220 is offset from the longitudinal axis 1 a. Aswill be described in detail below, the distal curve 228 a is oriented ina direction generally opposite that of the proximal curve 226 a tominimize contact of the perforating tip 229 against a surface of a lumenof a device, such as a transition step or taper or diameter change of atransseptal access system, through which the transseptal guidewire 220is introduced.

According to an exemplary embodiment, the end section 226 of thetransseptal guidewire 220 is ovalized such that the end section 226 hasa substantially non-circular cross section. As described above and shownin FIG. 7B, ovalizing end section 226 partly assists with biasing theend section 226 in a curved configuration to form the proximal curve 226a. When the end section 226 is ovalized or otherwise pressed, flattened,or formed, the end section 226 has a first dimension (such as a width)in a direction transverse to longitudinal axis 1 that is larger than asecond dimension (such as a thickness) in a second direction transverseto longitudinal axis 1.

According to an exemplary embodiment, the distal section 228 of thetransseptal guidewire 220 is also ovalized, thereby assisting withbiasing the distal section 228 in a second curved configuration to formthe distal curve 228 a. In one embodiment, the distal curve 228 a isformed by a bend or an angle in the distal section 228. Whether or notthe distal section 228 is ovalized, the perforating tip 229 may betapered or otherwise formed to a sharp perforating point.

As also illustrated in FIG. 10, the elongated body 222 of thetransseptal guidewire 220 has a portion 224 proximal of end section 226.Portion 224 has a substantially circular cross section relative to theend section 226. In one embodiment, portion 224 is an imagable sectionhaving a radiopaque marker such as a coil 225 coupled to the imagablesection 224. The radiopaque coil 225 is resiliently compressible in atleast the direction of the longitudinal axis 1 so it may be atraumaticwhen advanced from the right atrium into the left atrium after theintra-atrial septum has been punctured. According to an exemplaryembodiment, the radiopaque coil 225 has a pull force to withstand aminimum tensile force of at least about 0.67 lbs (approximately 3N).

According to an exemplary embodiment, the radiopaque coil 225 may bemade of a platinum/tungsten alloy, for example, and is sufficientlyvisible under fluoroscopy (x-ray) to assist with imaging of theoperative area. For example, the radiopaque coil may be 92% platinum and8% tungsten. Other radiopaque materials may also be used such aspalladium, palladium alloy, iridium, gold, tungsten, etc., or anyradiopaque material that can be coiled or otherwise configured to becoupled to the transseptal guidewire 220.

Additionally, a portion 221 of the elongated body 222 proximal to theimagable section 224 includes a tapered transition to imagable section224. According to an exemplary embodiment, the radiopaque coil 225 ispositioned adjacent the tapered transition and then held in place bycrimping a portion of the end section 226 opposite the taperedtransition. Because portion 221 has a diameter that is generally equalto or greater than the diameter of the imagable section 224, theradiopaque coil 225 is thus constrained on the imageable section 224.For example, portion 221 may have a diameter of about 0.015 inch and theimagable section 224 may have a diameter of about 0.008 inch. Thus, thelarger diameter of portion 221 constrains the radiopaque coil 225 to theimagable section 224 between the adjacent portion 221 and the ovalizedend section 226. Referring now to FIGS. 11A-11B, side views of thetransseptal guidewire 220 are illustrated. In one exemplary embodimentshown in FIG. 11A, before the transseptal guidewire 220 is provided withthe curves 226 a, 228 a, or when the transseptal guidewire 220 ismaintained in a constrained condition (such as when the guidewire 220 ispositioned within a lumen of a transseptal access system), the guidewire220 has a substantially straight configuration. Thus, in the pre-curvedor constrained condition, the portion of the transseptal guidewire 220that forms the proximal curve 226 a and the distal curve 228 a occupysubstantially the same longitudinal axis 1.

When the transseptal guidewire 220 is in an unconstrained or relaxedconfiguration, shown in FIGS. 11B and 12, the proximal curve 226 a andthe distal curve 228 a preferably occupy the same plane. In anotherembodiment, however, the proximal curve 226 a and the distal curve 228 aoptionally occupy respective planes that are angled with respect to eachother.

Referring to FIG. 11A, the linear length of the distal section 228 andend section 226 (i.e., from the perforating tip 229 to the beginning ofthe radiopaque coil 225) may be about 2 cm, although larger and smallerdimensions are contemplated. The total length of the elongate body 222of the transseptal guidewire 220 from the perforating tip 229 to theopposite end may be about 120 cm. It is contemplated, however, that theelongate body 222 may be any length to accommodate different patients ordifferent procedures. For example, a pediatric transseptal guidewire 220configured for use with children may have a shorter length compared to atransseptal guidewire 220 configured for use with adults.

According to an exemplary embodiment, the transseptal guidewire 220includes printed markers 240 a-c that may be used to indicate the lengthof the transseptal guidewire 220 at a specific location of the elongatebody 222. For example, the distance [K] from the perforating tip 229 tothe first printed marker 240 a may be about 70 cm, and about 71.7 cmwith a tolerance of +/−5.0 mm according to one exemplary embodiment.Also, the distance [L] from the perforating tip 229 to the secondprinted marker 240 b may be about 80 cm, or about 78.5 cm with atolerance of +/−5.0 mm according to one exemplary embodiment. It iscontemplated that other marker distances may also be used to allow aphysician to ascertain the insertion depth of the transseptal guidewire220 when used in a patient. For instance, after advancing a portion ofthe transseptal guidewire 220 into a patient, the physician may be ableto use the markers 240 a-c to determine how much farther to advance theguidewire 220 to the operative site.

According to an exemplary embodiment, the printed marker bands 240 a-cmay have a width [H] of about 5 mm with a tolerance of +/−1 mm.Additionally, the printed marker bands 240 a-c may be spaced at adistance [J] of about 2 mm from each other. It is also contemplated thatthe optional printed or otherwise applied marker bands 240 a-c may beany width [H] and spaced at any spacing distance [J] from each other solong as they allow a physician to ascertain the length of thetransseptal guidewire 220 at specific location of the elongate body 222,as described above.

According to another exemplary embodiment, the printed markers 240 a-cmay be attached to the transseptal guidewire 220 by pad printing to theportion 221 of the elongate body 222 proximal of the imageable section224. When the printed markers 240 a-c are attached to the transseptalguidewire 220, the printed marker diameter may be about 0.0005 inchlarger than the maximum diameter [I] of the elongate body 222. Accordingto an exemplary embodiment, the maximum diameter [I] of the elongatebody 222 depends on the use of the transseptal guidewire 220. Forexample, for a transseptal guidewire 220 used in conjunction with adilator (see, e.g., dilator 12, FIG. 2) the maximum diameter of theelongated body 222 may be about 0.050 inch. For a transseptal guidewire220 used in conjunction with an outer needle (see, e.g., needle 14, FIG.2), the maximum diameter [I] of the elongated body 222 may be about0.015 inch. It is contemplated that other diameters [I] may be selectedin order to configure the transseptal guidewire 220 for use with variouscomponents and procedures (e.g., so that the transseptal guidewire 220may be introduced or contained within the lumen of the dilator (12, FIG.2) or outer needle (14, FIG. 2) or any other component, or so that thetransseptal guidewire 220 can be used independent of other components).

As illustrated in FIG. 11B, in the unsupported or relaxed condition, theproximal curve 226 a of the transseptal guidewire 220 flexes or revertsinto an atraumatic configuration such as J-shape. Thus, the perforatingtip 229 is rendered atraumatic or less prone to puncturing or damagingtissue inadvertently. Furthermore, it is contemplated that the secondcurve (e.g., the distal curve 228 a and the resulting S-shape of theguidewire's distal portion) reduces the depth of penetration of theperforating tip 229, thereby further rendering the transseptal guidewire220 less traumatic in the unsupported condition.

According to an exemplary embodiment, at least a portion of the endsection 226 of an elongate body 222 may be heat treated, such as by aheat curving process, to a provide the flexible curved configuration ofthe proximal curve 226 a. The distal section 228 of the elongate body222 is also heat curved to provide the distal curve 228 a, thusproviding a configuration in which the perforating tip 229 is offsetfrom a longitudinal axis 1 a of the distal section 228. Due to theperforating tip 229 offset, the depth of penetration when thetransseptal guidewire 220 is in the constrained condition is preferablyless than the length of the distal curve 228 a. Additional aspects ofthe proximal curve 226 a and distal curve 228 a are described in furtherdetail below.

Referring now to FIG. 12, an enlarged view of the end section 226 anddistal section 228 is illustrated. According to an exemplary embodiment,the distal curve 226 a is formed by an arcuate or bent or angled portionof the distal section 226. The distal section 226, for example, may beheat curved or bent so that the curve diameter [E] of the proximal curve226 a is about 8 mm with a +/−1 mm tolerance, for example. It iscontemplated that the curve diameter [E] may be more or less than 8 mmto accommodate adult and pediatric or other uses of transseptalguidewire 220.

According to an exemplary embodiment, the arc curvature [F] of theproximal curve 226 a is generally about 180 degrees for both an adult orpediatric system. However, the arc curvature [F] may be more or lessthan 180 degrees depending on the desired relaxed atraumaticconfiguration. For example, a proximal curve 226 a with a larger arccurvature is generally less atraumatic in the unconstrained conditionthan a curve with a lower arc length. It is also contemplated that thearc curvature [F] may be selected from any such arc curvature to reducethe risk that the transseptal guidewire 220 might catch on the inside ofa needle (214, FIG. 15) or dilator (212, FIG. 16) or other component, aswill be described in detail below.

As illustrated in FIG. 12, the end section 226 has a length greater thanthe distal section 228. Thus, the arc length of the proximal curve 226 ais generally larger than the arc length of the distal curve 228 a toprovide sufficient curvature in the atraumatic configuration. A tipextension [D] extends distal of the proximal curve 226 a at a lengthabout 5.5 mm with a tolerance of +/−1 mm to the perforating tip 229, forexample. However, the tip extension [D] may be greater or less than 5.5mm for the transseptal guidewire 220 to remain atraumatic in the relaxedconfiguration. It is also contemplated that even if the tip extension[D] is 0 mm, the transseptal guidewire 220 will still function andremain atraumatic in the relaxed configuration.

According to an exemplary embodiment, in order to enhance the atraumaticcharacteristics of the transseptal guidewire 220, and also to prevent orreduce any tendency of the perforating tip 229 to catch in the lumen ofa transseptal needle or dilator or other component, the perforating tip229 may be offset from the longitudinal axis 1 a of a straight portionof the tip extension [D]. For an adult system, the perforating tip 229may be offset by a distance [C], measured in a direction perpendicularto the longitudinal axis 1 a, from about 0.01 to about 0.05 inch, butpreferably at a distance of about 0.03 inch. For a pediatric system, theperforating tip 229 may be offset from the longitudinal axis 1 a at adistance [C] from about 0.005 to about 0.03 inch, but preferably at adistance of about 0.02 inch. It is contemplated that other offsetdistances [C] may be selected to prevent the perforating tip 229 fromcatching on the inside of a component such as a transseptal needle ordilator, which components may include a transition step or a diameterreduction, as will be described in further detail below.

Referring now to FIGS. 7B, 10, and 12, according to the illustratedembodiment, the ovalized or flattened portion of the end section 226 isgenerally about 0.75 inch long. The end section 226, however, may be anylength sufficient to provide the proximal curve 226 a. The thickness [A]of the ovalized portion may be configured to be between about 0.008 andabout 0.014 inch, but preferably about 0.012 inch. Other thicknesses mayalso be used to allow the end section to be biased in the curvedconfiguration.

As described above with reference to FIG. 7B, the first dimension X ofend section 226 is formed in a first direction transverse tolongitudinal axis 1 of elongate body (222, FIG. 10) and second dimensionY is formed in a second direction transverse to longitudinal axis 1.First dimension X is larger than second dimension Y, thus end section226 is thinner in thickness [A] and more flexible in at least onedirection as compared to proximal portion 221 and imagable section 224of the transseptal guidewire 220.

Referring now to FIG. 13, a method of confirming the dimensions of atransseptal guidewire 220 is illustrated. The template illustrated inFIG. 13 permits visual inspection of a guidewire 220 to confirm that thecurved configuration of the distal portion is within a specifiedtolerance. In use, the template is placed on a flat surface and thetransseptal guidewire 220 is positioned over the template. The distalportion of the transseptal guidewire 220 is aligned to the “ALIGN HERE”position. The position of the perforating tip 229 of the transseptalguidewire 220 is then compared to the rectangular target formed on thetemplate. If the perforating tip 229 of the transseptal guidewire 220falls within the rectangular target, then the curved end of thetransseptal guidewire 220 has been manufactured appropriately and wouldpass this aspect of inspection. If the perforating tip 229 of thetransseptal guidewire 220 falls outside the rectangular target, then thecurved end of the transseptal guidewire 220 has been manufacturedinappropriately and would fail this aspect of inspection.

Referring now to FIGS. 14, 15, 16, and 17A-17D, transseptal accesssystems and methods of perforating an intra-atrial septum 104 (FIG. 1)are illustrated. As shown in FIG. 17A, a transseptal access system suchas transseptal access system 250 may include an assembly of a dilator212 a and a transseptal needle 214. Alternatively, the transseptalaccess system may include either the dilator 212, 212 a or the needle214 alone or in combination with other components.

According to the embodiment illustrated in FIG. 15, the transseptalaccess system includes transseptal needle 214, which includes a wall 235defining a lumen 215. The lumen 215 has a first section 216 and a secondsection 217 distal of the first section 216. A transition step 218 isdefined between the first section 216 and the second section 217.

According to one exemplary method of perforating the intra-atrialseptum, the transseptal guidewire 220 is inserted within the lumen 215of the transseptal needle 214. Because the lumen 215 of the needle 214has a diameter generally larger than the largest diameter of thetransseptal guidewire 220, the elongate body 222 of the guidewire 220may be urged into contact with the wall 235 of the needle 214 when thetransseptal guidewire 220 is constrained in the lumen 215. This is aresult of various factors, including the spring effect caused by theproximal curve formed in the transseptal guidewire, the generalcurvature of the needle 214 as it navigates the vasculature of apatient, and the rotation of the needle 214 and the transseptalguidewire 220 with respect to one another.

In order to reduce the possibility that the distal tip 229 of thetransseptal guidewire 220 will engage or contact an interior surface ofthe transseptal needle 214, thus becoming caught or prevented from beingadvanced out of the lumen 215 of the needle 214 smoothly, theperforating tip 229 of the transseptal guidewire 220 is laterally offsetfrom the longitudinal axis 1 a (FIG. 12). Thus, when the transseptalguidewire 220 is inserted within the lumen 215 of the transseptal needle214, the perforating tip 229 of the transseptal guidewire 220 isconfigured to be offset from the inner surface of the wall 235 of thetransseptal needle 214. This offset distance is measured as the distancebetween the perforating tip 229 of the transseptal guidewire 220 and thesurface of the wall, along a direction perpendicular to the surface ofthe wall. This distance is illustrated by the dimension “O” shown inFIG. 16

The distance between the wall 235 and the perforating tip 229 is equalto or larger than the transition step 218 defined between first section216 and second section 217. This offset therefore reduces the tendencyof the tip 229 to contact or engage the near-side transition step 218(i.e., the transition step 218 closest to the wall surface from whichthe offset is measured). Additionally, the offset between the wall 235and the perforating tip 229 is equal to or smaller than the sum of thetransition step 218 and the inner diameter of the second section 217 toallow the perforating tip 229 to be advanced into the second section217. This offset therefore reduces the tendency of the tip 229 tocontact or engage the far-side transition step 218 (i.e., the transitionstep 218 farthest from the wall surface from which the offset ismeasured). Thus, contact between the perforating tip 229 and the wall235 and transition step 218 of the transseptal needle 214 is reduced oravoided as the perforating tip is advanced through the lumen 215 fromthe first section 216 to the second section 217.

According to an exemplary embodiment of the transseptal needle 214, thefirst section 216 has a first inner diameter and the second section 217has a second inner diameter that is smaller than the first diameter. Forexample, the diameter of the first section 216 of the transseptal needle214 in an adult size may be about 0.032 inch and the diameter of thesecond section 217 may be about 0.020 inch. For such an adult needle214, therefore, at the transition step 218 the diameter of the needlelumen 215 may change from about 0.032 inch to about 0.020 inch. Thetransition step 218 for such an adult needle 214 is about 0.006 inch andcorresponds in size to half the difference between the diameter of thefirst section 216 and the diameter of the second section 217.

Similarly, the diameter of the first section 216 of the transseptalneedle 214 in pediatric size may be about 0.027 inch and the diameter ofthe second section 217 may be about 0.013 inch, for example. For such apediatric needle 214, therefore, at the transition step 218 the diameterof the needle lumen 215 changes from about 0.027 inch to about 0.013inch. The transition step 218 is therefore about 0.007 inch for such aneedle, corresponding in size to half the difference between thediameter of the first section 216 and the diameter of the second section217.

According to one preferred embodiment, the perforating tip 229 of thetransseptal guidewire 220 is configured to be offset from the innersurface of the wall 235 of the transseptal needle 214 a distance that isequal to or smaller than the second, smaller diameter of the lumen 215of the transseptal needle 214, thereby reducing or avoiding contactbetween the perforating tip 229 of the transseptal guidewire 220 and thewall 235 as the perforating tip 229 is advanced distally through thetransseptal needle 214. Also, the perforating tip 229 of the transseptalguidewire 220 is configured to be offset from the wall 235 of thetransseptal needle 214 a distance that is equal to or larger than halfthe difference between the first diameter and the second diameter of thelumen 215 of the transseptal needle 214.

According to another embodiment, the perforating tip 229 of thetransseptal guidewire 220 is configured to be offset from the wall 235of the transseptal needle 214 a distance that is equal to or larger thanthe transition step 218 defined between the first and second sections216, 217 of the lumen 215 of the transseptal needle 214, but equal to orsmaller than the sum of the transition step 218 and the second diameter,thereby reducing contact between the perforating tip 229 and thetransition step 218 as the perforating tip 229 is advanced through thelumen 215 from the first section to the second section of the lumen.

According to one exemplary embodiment best suited for use with an adultsize transseptal access system, the perforating tip 229 of thetransseptal guidewire 220 is configured to be offset from the wall ofthe transseptal access system a distance that is between about 0.01 inchand about 0.05 inch, a dimension selected depending on the size and typeof access system. When the perforating tip 229 is in a relaxedconfiguration, the perforating tip 229 may be offset from thelongitudinal axis 1 a of the distal section 228 a distance [C] fromabout 0.01 to about 0.05 inch, again a dimension selected depending onthe size and type of access system. In one preferred embodiment, theperforating tip 229 in the relaxed configuration is offset from thelongitudinal axis 1 a a distance of about 0.03 in.

According to an exemplary embodiment best suited for use with apediatric size transseptal access system, the perforating tip 229 of thetransseptal guidewire 220 is configured to be offset from the wall ofthe transseptal access system a distance that is between about 0.005inch and about 0.03 inch, a dimension selected depending on the size andtype of access system. When the perforating tip 229 is in a relaxedconfiguration, the perforating tip 229 may be offset from thelongitudinal axis 1 a of the distal section 228 a distance [C] fromabout 0.005 to about 0.03 inch, again a dimension selected depending onthe size and type of access system. In one preferred embodiment, theperforating tip 229 in the relaxed configuration is offset from thelongitudinal axis 1 a a distance of about 0.02 in.

Referring now to FIG. 16, an embodiment of the transseptal dilator 212,which is optionally used as a component of the transseptal access system250, is illustrated. The transseptal dilator 212 has a wall 232 defininga lumen 213 that extends from a proximal section 230 to a distal opening231. The lumen 213 of the dilator 212 is reduced in size from a firstdiameter in the proximal section 230 to a second diameter at the distalopening 231. The second diameter is generally smaller than the firstdiameter. For example, the diameter of the lumen 213 in the proximalsection 230 may range from about 0.050 inch to about 0.065 inch. Thedistal opening 231, however, may have a smaller diameter than theproximal section 230 that may range from about 0.032 inch to about 0.038inch.

According to an exemplary embodiment, the transseptal guidewire 220 isconfigured to be inserted into the lumen 213 of the transseptal dilator212. When the transseptal guidewire 220 is constrained within the lumen213, the perforating tip 229 is offset from the wall 232 of the dilator212 by a distance [O] that is smaller than the diameter of the distalopening 231. For example, the offset distance [O] may be equal to orlarger than half the difference between the diameter of the proximalsection 230 and the diameter of the distal opening 231. According to anexemplary embodiment, for an adult system, the offset distance [O] isbetween about 0.01 inch and about 0.05 inch. For a pediatric system,however, the offset distance [O] may be between about 0.005 inch andabout 0.03 inch. These offsets may vary depending on the size and typeof the transseptal dilator 212 and other factors. This offsetfacilitates reducing or avoiding contact between the perforating tip 229of the transseptal guidewire 220 and the wall 232 of the transseptaldilator 212 as the perforating tip 229 is advanced from the proximalsection 230 and distally through the distal opening 231 of thetransseptal dilator 212.

According to the illustrated embodiment in FIGS. 17A-17D, a transseptalaccess system 250 includes a transseptal needle 214 and a dilator 212 a.The dilator 212 a includes a first section 233 and a second section 234distal of the first section 233. The lumen in the first section 233 hasa diameter generally larger than the lumen in the second section 234,and a transition step 219 is defined between the first and secondsections.

As shown in FIG. 17A, the transseptal needle 214 is inserted orpositioned with the lumen 213 a of the dilator 212 a, and a transseptalguidewire 220 is constrained in the lumen 215 of the needle 214. As theguidewire 220 is advanced through the lumen of the needle 214, theperforating tip 229 of the guidewire 220 is offset from the wall of theneedle 214 to prevent the guidewire 220 from being caught by thetransition step 218. Additionally, the perforating tip 229 offsetreduces or avoids contact of the perforating tip 229 against the wall ofthe second section 217 of the needle 214.

As shown in FIG. 17B, when the perforating tip 229 is advanced throughthe lumen (215, FIG. 15) of the needle 214 and into the lumen (213 a,FIG. 17 a) of the dilator 212 a, a portion of the elongate body (222,FIG. 10) of the transseptal guidewire 220 contacts the wall of thedilator 212 a. The perforating tip 229 is offset at a distance away fromthe wall of the dilator 212 a so that it does not get caught in thetransition step 219 of the dilator 212 a. Additionally, the offsetprevents or avoids contact of the perforating tip 229 against the wallof the second section 234 of the dilator 212 a.

As shown in FIG. 17C, when the perforating tip 229 is advanced beyondthe distal opening 231 of the dilator 212 a, the transseptal guidewire220 flexes or reverts to its relaxed configuration. As described above,in the relaxed configuration, the transseptal guidewire 220 is biased ina curved configuration to define a proximal curve (226 a, FIG. 10) and adistal curve (228 a, FIG. 10), such that the perforating tip 229 isoffset from the longitudinal axis (1 a, FIG. 12). Depending on the sizeof the lumen and the size of the transseptal guidewire 220, the offsetof the perforating tip 229 in the relaxed configuration may be the sameas or different from the offset of the perforating tip 229 from the wallof a lumen in which it is positioned in the constrained configuration.For example, the offset of the perforating tip 229 in the relaxedconfiguration (shown as distance [C] in FIG. 12) may be equal to orgreater than or smaller than the offset of the perforating tip 229 fromthe wall of the dilator 212 a (shown as distance “O” in FIG. 16) or theoffset of the perforating tip 229 from the wall of the transseptalneedle 214 (the distance from the wall 235 to the tip 229 measured in adirection perpendicular to the wall 235 in FIG. 15) in the constrainedconfiguration.

When the distal curve 228 a is unsupported (i.e., relaxed), the distalcurve 228 a renders the transseptal guidewire 220 less traumatic andreduces the depth of penetration of the tip 229 of the transseptalguidewire 220. This exemplary feature of transseptal guidewire 220confers a significant benefit in that the distal second curve will notpenetrate into the lateral left atrial wall because of the deflection ofthe unsupported curve. It is beneficial to avoid or reduce suchpenetration in the event that the perforating tip 229 contacts thelateral left atrial wall, and the distal curve 228 a reduces oreliminates the tendency for such penetration and/or limits the depth ofany such penetration.

Referring now to FIG. 17D, after the transseptal guidewire 220 hasperforated the fossa ovalis of the intra-atrial septum, the needle 214may be advanced within the dilator 212 a of the transseptal accesssystem 250 so that a shoulder on an exterior surface of the needle 214abuts the transition step 219 of the dilator 212 a. Thus, a portion ofthe needle 214 may extend beyond the distal opening 231 of thetransseptal dilator 212 a and into a portion of the left atrium.

Accordingly, a surgical device is provided, according to exemplaryembodiments of the invention, that reduces the risk of inadvertentperforation or trauma in transseptal procedures with the added benefitof confirming the puncture location prior to dilation. In particular,such embodiments provide accurate placement and safe access to the leftatrium through the atrial septum. The device, according to exemplaryembodiments, preferably performs with commercially available transseptalneedle systems and allows for safer and easier penetration of atransseptal needle through the atrial septum. Furthermore, according toother exemplary embodiments of the invention, the surgical devicereduces or prevents the device from catching on a surface on the insideof components of transseptal access systems. Thus, the devicefacilitates ease of use by physicians during such surgical procedures.

Although the invention is illustrated and described herein withreference to specific embodiments, the invention is not intended to belimited to the details shown. Rather, various modifications may be madein the details within the scope and range of equivalents of the claimsand without departing from the invention. Additionally, the materials,components, configurations, manufacturing processes and other featuresof one or more of the embodiments described or illustrated herein areoptionally utilized in other such embodiments described or illustratedherein. For example, the materials, components, configurations,manufacturing processes and other features of the embodiments describedwith reference to FIGS. 1-9 are optionally utilized in the embodimentsdescribed with reference to FIGS. 10-17D, and the materials, components,configurations, manufacturing processes and other features of theembodiments described with reference to FIGS. 10-17D are optionallyutilized in the embodiments described with reference to FIGS. 1-9.

What is claimed:
 1. A system configured to perforate the intra-atrialseptum comprising: a transseptal access system defining a lumen, thelumen having a first section with a first diameter, a second sectionwith a second diameter smaller than the first diameter, and a transitionstep defined between the first and second sections; a transseptalguidewire configured to be inserted within the lumen of the transseptalaccess system having an elongated body and an end section biased in acurved configuration to define a proximal curve and a distal curvetogether forming a generally S-shaped curvature terminating at a sharpdistal perforating tip; the S-shaped curvature of the end sectionthereby reducing contact between the perforating tip of the transseptalguidewire and the transition step of the transseptal access system asthe perforating tip is advanced through the lumen from the first sectionto the second section of the lumen.
 2. The system of claim 1, thetransseptal guidewire having a first position in which a distal sectionof the transseptal guidewire is supported by the transseptal accesssystem and a second position in which the distal section of thetransseptal guidewire extends from and is not supported by thetransseptal access system, the transseptal guidewire being configured tobe effective to perforate the intra-atrial septum when it is in thefirst position and to be less effective to perforate when it is in thesecond position.
 3. A system configured to perforate the intra-atrialseptum comprising: a transseptal access system defining a lumen, thelumen having a first section with a first diameter, a second sectionwith a second diameter smaller than the first diameter, and a transitionstep defined between the first and second sections; a transseptalguidewire configured to be inserted within the lumen of the transseptalaccess system having an elongated body, a sharp perforating tip, and anS-shaped curvature terminating at the sharp perforating tip for reducingcontact between the perforating tip of the transseptal guidewire and thetransition step of the transseptal access system as the perforating tipis advanced through the lumen from the first section to the secondsection of the lumen.
 4. The system of claim 3, the S-shaped curvatureoffsetting the perforating tip from an axis of the elongated body of thetransseptal guidewire.
 5. The system of claim 4, the S-shaped curvatureincluding at least one of a curve, a bend, or an angle formed in thetransseptal guidewire.
 6. The system of claim 3, the transseptalguidewire having a first position in which a distal section of thetransseptal guidewire is supported by the transseptal access system anda second position in which the distal section of the transseptalguidewire extends from and is not supported by the transseptal accesssystem, the transseptal guidewire being configured to be effective toperforate the intra-atrial septum when it is in the first position andto be less effective to perforate when it is in the second position. 7.A system configured to perforate the intra-atrial septum comprising: atransseptal access system including a wall defining a lumen extending toa distal opening; a transseptal guidewire configured to be inserted intothe lumen of the transseptal access system, the transseptal guidewirehaving a distal section including a generally S-shaped curvatureterminating at a sharp perforating tip; the transseptal guidewire havinga first position in which the distal section of the transseptalguidewire is supported by the wall of the transseptal access system anda second position in which the distal section of the transseptalguidewire extends fully outwardly from the distal opening of thetransseptal access system and is not supported by the transseptal accesssystem, the transseptal guidewire being configured to be effective toperforate the intra-atrial septum when it is in the first position andto be less effective to perforate when it is in the second position. 8.The system of claim 7, wherein the distal section of the transseptalguidewire has a solid cross-section.
 9. The system of claim 7, theS-shaped curvature including a proximal curve and a distal curveoriented in a direction generally opposite that of the proximal curve,thereby reducing contact between the perforating tip of the transseptalguidewire and the wall of the transseptal access system as theperforating tip is advanced through the lumen.
 10. The system of claim7, the transseptal access system including a transseptal needle and thetransseptal guidewire being configured to be inserted into a lumen ofthe transseptal needle.
 11. The system of claim 7, the transseptalguidewire having a solid, unitary structure.
 12. The system of claim 7,the transseptal guidewire being configured to prevent inadvertentpuncture when it is in the second position.
 13. A system configured toperforate the intra-atrial septum comprising: a transseptal accesssystem including a wall defining a lumen extending from a proximalsection to a distal opening, the lumen being reduced in size from afirst diameter in the proximal section to a second diameter at thedistal opening, the second diameter being smaller than the firstdiameter; a transseptal guidewire configured to be inserted into thelumen of the transseptal access system, the transseptal guidewire havinga distal curvature terminating at a sharp perforating tip, theperforating tip extending along an axis that is angled with respect to alongitudinal axis of the transseptal guidewire, wherein the perforatingtip of the transseptal guidewire is configured to be offset from thewall of the transseptal access system a distance that is equal to orsmaller than the second diameter of the lumen of the transseptal accesssystem, thereby reducing or avoiding contact between the perforating tipof the transseptal guidewire and the wall as the perforating tip isadvanced distally through the distal opening of the transseptal accesssystem.
 14. The system of claim 13, wherein the perforating tip of thetransseptal guidewire is configured to be offset from the wall of thetransseptal access system a distance that is equal to or larger thanhalf the difference between the first diameter and the second diameterof the lumen of the transseptal access system.
 15. The system of claim13, wherein the perforating tip of the transseptal guidewire isconfigured to be offset from the wall of the transseptal access system adistance that is between about 0.01 inch and about 0.05 inch.
 16. Thesystem of claim 13, wherein the perforating tip in a relaxedconfiguration is offset from the longitudinal axis a distance from about0.01 to about 0.05 inch.
 17. The system of claim 16, the perforating tipin the relaxed configuration being offset from the longitudinal axis adistance of about 0.03 in.
 18. The system of claim 13, wherein theperforating tip of the transseptal guidewire has a solid cross-section.19. The system of claim 13, the transseptal guidewire having a firstposition in which the distal curvature of the transseptal guidewire issupported by the transseptal access system and a second position inwhich the distal curvature of the transseptal guidewire extends from andis not supported by the transseptal access system, the transseptalguidewire being configured to be effective to perforate the intra-atrialseptum when it is in the first position and to be less effective toperforate when it is in the second position.
 20. The system of claim 19,wherein the distal curvature reduces the depth of penetration of theperforating tip of the transseptal guidewire when the distal curvatureis unsupported and the depth of penetration is less than the length ofthe distal curvature.
 21. A system configured to perforate theintra-atrial septum comprising: a transseptal access system having atransseptal needle including a sharp needle tip and a wall defining alumen, the lumen having a first section with a first diameter, a secondsection with a second diameter smaller than the first diameter, and atransition step defined between the first and second sections; atransseptal guidewire configured to be inserted within the lumen of thetransseptal needle, the transseptal guidewire having an elongated bodyand a distal curvature terminating at a sharp perforating tip extendingalong an axis that is angled with respect to a longitudinal axis of thetransseptal guidewire, wherein the perforating tip of the transseptalguidewire is configured to be offset from the wall of the transseptalneedle a distance that is equal to or larger than the transition stepdefined between the first and second sections of the lumen of thetransseptal needle but equal to or smaller than the sum of thetransition step and the second diameter, thereby reducing contactbetween the perforating tip and the transition step as the perforatingtip is advanced through the lumen from the first section to the secondsection of the lumen.
 22. The system of claim 21, wherein the secondsection is distal of the first section.
 23. The system of claim 21,wherein the transition step corresponds in size to half the differencebetween the first diameter and the second diameter.
 24. The system ofclaim 21, wherein a lateral offset of the perforating tip of thetransseptal guidewire corresponds to a distance from the longitudinalaxis along a perpendicular axis, the distance being from about 0.01 inchto about 0.05 inch.
 25. The system of claim 21, wherein theconfiguration of the perforating tip of the transseptal guidewireextends from the inner surface of the lumen a distance that is smallerthan the distance across the lumen.
 26. The system of claim 21, whereinthe perforating tip in a relaxed configuration is offset from thelongitudinal axis of the transseptal guidewire a distance from about0.01 to about 0.05 in.
 27. The system of claim 26, the perforating tipin the relaxed configuration being offset from the longitudinal axis adistance of about 0.03 inch.
 28. The system of claim 21, the transseptalguidewire having a first position in which the distal curvature of thetransseptal guidewire is supported by the transseptal needle and asecond position in which the distal curvature of the transseptalguidewire extends from and is not supported by the transseptal needle,the transseptal guidewire being configured to be effective to perforatethe intra-atrial septum when it is in the first position and to be lesseffective to perforate when it is in the second position.
 29. The systemof claim 21, the distal curvature laterally offsetting the perforatingtip from the longitudinal axis of the transseptal guidewire, wherein thedistal curvature reduces the depth of penetration of the perforating tipof the transseptal guidewire when the distal curvature is unsupported bythe transseptal access system.
 30. The system of claim 29, wherein thedepth of penetration is less than the length of the distal curvature.31. A system configured to perforate the intra-atrial septum comprising:a transseptal access system defining a lumen, the lumen having a firstsection with a first diameter, a second section with a second diametersmaller than the first diameter, and a transition step defined betweenthe first and second sections; a transseptal guidewire configured to beinserted within the lumen of the transseptal access system having anelongated body, an end section biased in a curved configuration todefine a proximal curve, and a distal section having a central axisbiased in a curved configuration to define a distal curve terminating ata sharp distal perforating tip; the distal curve extending generallyalong the same plane as the proximal curve and being oriented in adirection generally opposite that of the proximal curve, therebyreducing contact between the distal section and the perforating tip ofthe transseptal guidewire and the transition step of the transseptalaccess system as the distal section and the perforating tip are advancedthrough the lumen from the first section to the second section of thelumen.
 32. A system configured to perforate the intra-atrial septumcomprising: a transseptal access system having a transseptal needle, thetransseptal access system including a wall defining a lumen extendingfrom a proximal section to a distal opening, the lumen being reduced insize from a first diameter in the proximal section to a second diameterat the distal opening, the second diameter being smaller than the firstdiameter; a transseptal guidewire configured to be inserted into thelumen of the transseptal access system, the transseptal guidewire havinga distal curvature terminating at a sharp perforating tip extendingalong an axis that is angled with respect to a longitudinal axis of thetransseptal guidewire, wherein the perforating tip of the transseptalguidewire is configured to be offset from the wall of the transseptalaccess system a distance that is equal to or smaller than the seconddiameter of the lumen of the transseptal access system, thereby reducingor avoiding contact between the perforating tip of the transseptalguidewire and the wall as the perforating tip is advanced distallythrough the distal opening of the transseptal access system.
 33. Asystem configured to perforate the intra-atrial septum comprising: atransseptal access system including a wall defining a lumen extending toa distal opening; a transseptal guidewire configured to be inserted intothe lumen of the transseptal access system, the transseptal guidewirehaving a distal curvature terminating at a sharp perforating tipextending along an axis that is angled with respect to the wall of thetransseptal access system; the transseptal guidewire having a firstposition in which the distal curvature of the transseptal guidewire issupported by the wall of the transseptal access system and a secondposition in which the distal curvature of the transseptal guidewireextends fully outwardly from the distal opening of the transseptalaccess system and is not supported by the transseptal access system, thetransseptal guidewire being configured to be effective to perforate theintra-atrial septum when it is in the first position and to be lesseffective to perforate when it is in the second position.
 34. The systemof claim 33, wherein the perforating tip of the transseptal guidewirehas a solid cross-section.
 35. The system of claim 33, the transseptalguidewire having a proximal curve and a distal curve oriented in adirection generally opposite that of the proximal curve, therebyreducing contact between the perforating tip of the transseptalguidewire and the wall of the transseptal access system as theperforating tip is advanced through the lumen.
 36. The system of claim33, the transseptal access system including a transseptal needle and thetransseptal guidewire being configured to be inserted into a lumen ofthe transseptal needle.
 37. The system of claim 33, the transseptalguidewire having a solid, unitary structure.
 38. The system of claim 33,the transseptal guidewire being configured to prevent inadvertentpuncture when it is in the second position.